Poison Control Centers and TESS. Role of Regional Poison Control Center 24-hour resource for poison...
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Transcript of Poison Control Centers and TESS. Role of Regional Poison Control Center 24-hour resource for poison...
Poison Control Centers and TESS
Role of Regional Poison Control Center
24-hour resource for poison information, prevention, education and clinical toxicology consultation
Types of calls include: pediatric ingestions, overdoses, abuse, adverse reactions, therapeutic misadventures, environmental, occupational, natural products, plants, envenomations, etc.
US Poison Centers Available 24-7 65 US Poison Centers Universal access through 1-800-222-
1222 Specialized services
Language translation Hearing Impaired
Available to public and health professionals
New Telephone Number
Nationwide toll-free number routes caller to one of 65 poison centers based on area code and exchange
Coverage: 50 States, DC and Puerto Rico
Poison Center Staff
Specialists in Poison Information: pharmacists and nurses with additional training in clinical toxicology
Clinical Toxicologists Medical Toxicologists Educators
Regional Poison Control Centers
Numerous resources on-site Interface with regional treatment
facilities pre -hospital providers clinical laboratories health care facilities
• Outreach education
Regional Poison Control Centers
• Disaster preparedness and response
• Epidemiologic surveillance
Calls to US Poison Centers 2001
2.2 million poison exposures 860,000 information calls 111,000 animal exposures
Exposure Management Public Call
History of exposure Assessment of toxicity Triage – home, ED Home treatment recommendations Healthcare provider
recommendations Prevention education Follow-up
Exposure Management HCF Call
History of exposure Assessment of toxicity Differential diagnosis Clinical toxicology consultation Specific treatment
recommendations Follow-up
Poisoning History Patient Status Substance Amount Time Since Exposure Reason Past Medical History First Aid Provided Age/gender/weight
Follow-up call Public
To ensure that recommendations were understood
Situation resolving Documentation of outcome
HCF Review and update recommendations as
patient status changes Documentation of outcome
TESS Toxic Exposure Surveillance System
is the database of the American Association of Poison Control Centers
Compiled by the AAPCC in cooperation with majority of US Poison Centers
64 poison centers reported in 2001 Requirement for certified regional
poison centers
Toxic Exposure Surveillance System Single largest database on poison
exposures in US 1983 to present Hospitalized and home management
for poison exposures > 31 million poison exposures
reported to date Strong consistent temporal
relationship
History of TESS Deficiencies of US National
Clearinghouse for PCCs PCC Driven FDA fellowship to organize, pilot and
implement a functional system, develop software, instructions, generic classification scheme, uniform reporting forms
Pilot tested in 1983 National implementation in 1984
TESS Data Collection
Computerized data collection program at each poison center
Data collected at time of telephone call
Autoupload of data to AAPCC in real time
Medical records retained on-site
Human Exposures
3000
3500
4000
4500
5000
5500
6000
6500
7000
7500
8000
1/1/2000 7/1/2000 12/30/2000 6/30/2001 12/29/2001 6/29/2002 12/28/2002
Cas
es/D
ay
Weekdays
Weekends
All Info Calls 2000-2002
0
500
1000
1500
2000
2500
3000
3500
4000
4500
8/28/1999 3/15/2000 10/1/2000 4/19/2001 11/5/2001 5/24/2002 12/10/2002 6/28/2003
Date
Cas
es/D
ay
weekday
weekend
Use of TESS Data TESS Annual Report
September issue of Am J Emerg Med www.aapcc.org
Identification of new product risks Post-marketing surveillance Public health surveillance Regulatory actions Education program development Research
TESS Data Collection
Case Information Call type Caller Site Exposure Site Reason Relationship of caller to patient
(optional) Location information (zipcode/exchange)
Caller/Exposure Site Own Residence Other Residence Health Care Facility School Restaurant Public area Workplace Other Unknown
Reason for Exposure Unintentional
General Environmental Occupational Therapeutic error Unintentional
misuse Food poisoning Bite/sting Unknown
Intentional Suicide Misuse Abuse Unknown
Other Malicious Contamination
Adverse Reaction
TESS Data Collection
Patient Data Age Gender Pregnant
TESS Data Collection Exposure Information
Time since exposure (optional) Substance Clinical Effects Route of Exposure Therapy provided Management Site Medical Outcome
Substance Information Coded to brand and formulation if
known Coded by generic or category if
unknown Number of substances Quantity Certainty Dosage form
Clinical Effects Cardiovascular Dermatologic Gastrointestinal Heme/hepatic Neurologic
Ocular Respiratory Renal/
genitourinary Respiratory Miscellaneous
Specific definitions – some require objective findingsCoded as related, unrelated or unknown if related
Therapy Provided
No therapy Observation only Refused Unknown Decontamination Other therapies
Management Site
Onsite – non health care facility Already in/enroute to HCF Referred to HCF Other (nursing home, detox, jail) Unknown
Management Site - HCF
Treated and released from ED Admitted to critical care Admitted to non-critical care Admitted for psychiatric care Lost to follow-up Refused referral (referred only)
Medical Outcome No effect Minor effect Moderate effect Major effect Death
Unknown, non-toxic
Unknown, minimally toxic
Unknown, potentially toxic
Unrelated
Duration of symptoms
TESS Data Collection
Scenarios Pesticide exposures Therapeutic errors
Information not available from TESS
Narrative description Patient identifiers: name, address,
birthdate Socioeconomic data
Use of TESS DataSpecific Examples
Iron formulations Acetonitrile Pesticides
Arsenic containing rodenticides Mouthwash Rx OTC switch (ibuprofen, H2
antagonists, nicotine patch)
Quality Control
Data Collection Manual and Workbook
Center specific chart audits Electronic data checks and edits Data quality factors Fatality verifications
What TESS Can Not Do Poison Exposure vs Poisoning Absence of clinical effects
Prompt treatment or guidance by PCC Limited toxicity of substance Limited amounts/concentrations of substance Exposure suspected but did not occur
Telephone reporting Passive reporting Increased reports ≠increased hazard Calculate incidence of poisoning
Exposure Site
Site of
Caller (%)
Site of Exposure
(%)
Residence 76.3 89HCF 13.9 0.3Workplace 1.6 2.5School 0.8 1.6
Route
Route % All % Fatal
Ingestion 76.2 76.4
Dermal 7.6 1.1
Inhalation 6.1 8.5
Ocular 5.4 0.1
TESS 2001
Management Site
Refused Referral
2%
On-site74%
HCF22%
Other1%
Unknown1%
TESS 2001
Management SiteHealth Care Facility
ICU admit14%
Lost16%
Psych8%
Non ICU7%
ED Only74%
TESS 2001
Most common substances by Age
< 6 years Cosmetics Cleaners Analgesics Foreign bodies Topicals Plants Cold preps
Adults Analgesics Sedative/hypnotics Cleaners Antidepressants Bites/stings Alcohols Food poisoning
Substances Related to Deaths Analgesics (pain
killers) Antidepressants Sedatives/
hypnotics/antipsychotics
Stimulants and street drugs
Cardiovascular drugs
Alcohols Anticonvulsants Muscle Relaxants Gases and Fumes Chemicals
Impact of Space Shuttle
Figure 1. TX and LA Inform ation Calls 2/3/2002 to 2/8/2003
0
100
200
300
400
500
600
700
2/3/2002 3/25/2002 5/14/2002 7/3/2002 8/22/2002 10/11/2002 11/30/2002 1/19/2003
date
calls
per
day w eekend days
w eekdays
1-Feb-03
Information calls to PCCs
Fig 2. All US PCC calls (excluding TX, LA) 2/3/02 through 2/8/03
0
500
1000
1500
2000
2500
3000
3500
4000
4500
2/3/2002 3/25/2002 5/14/2002 7/3/2002 8/22/2002 10/11/2002 11/30/2002 1/19/2003
date
calls
per
day w eekday info
callsw eekend dayinfo calls1-Feb-03
Carbon monoxideTESS Carbon Monoxide Human Exposures by day 1/93 to 2//03
0
100
200
300
400
500
600
12/31/1992 5/15/1994 9/27/1995 2/8/1997 6/23/1998 11/5/1999 3/19/2001 8/1/2002
date
N
Snake Bites
0
5
10
15
20
25
8/28/1999 3/15/2000 10/1/2000 4/19/2001 11/5/2001 5/24/2002 12/10/2002 6/28/2003
Cas
es/D
ay
Pesticide Exposures (Excl Rodenticides) by Day
0
100
200
300
400
500
600
6/15/1994 10/28/1995 3/11/1997 7/24/1998 12/6/1999 4/19/2001 9/1/2002 1/14/2004
Cas
es p
er d
ay, a
ll ag
es, a
ll ro
utes
Summary Comprehensive poisoning
surveillance database Includes cases managed in and
outside HCF Voluntary Telephone reports Consistent temporal nature Identification of public health hazards
Questions